Paraplegic PCI; Sonic Renal Denervation; Temporary Polymer in T2D

Exploratory studies of note at the CRT meeting

WASHINGTON -- Among the abstracts presented at the Cardiovascular Research Technologies meeting here were a few standouts providing data on novel endovascular technology and unexplored populations in percutaneous coronary intervention (PCI).

All were published online as a supplement to the February 26 issue of JACC: Cardiovascular Interventions.

Three out of every 1,000 adults admitted for acute MI in 2007-2013 had paraplegia, the New York State Inpatient Database showed. This group mostly got medical therapy without cardiac catheterization (83.7%); relatively few got a diagnostic cardiac catheterization without revascularization (7.2%), PCI (7.1%) or coronary artery bypass grafting (CABG, 1.9%).

Propensity score matching showed that paraplegics who got revascularization had shorter hospital stays and were less likely to die before discharge, but had higher hospital charges, according to Xuming Dai, MD, PhD, of University of North Carolina at Chapel Hill, and colleagues.

Further comparison between PCI and CABG groups found that PCI was associated with less mortality, shorter hospital stays, and lower hospital charges.

"Acute MI in patients with paraplegia is a small but unique subgroup of acute MI patients that deserves attention," the researchers said.

Biodegradable-Polymer DES in Diabetes

An abluminal-coated sirolimus-eluting stent with a biodegradable polymer showed promise for PCI in patients with diabetes, one researcher reported.

One year after implantation of the Abluminus DES+, diabetes patients were not at increased risk of major adverse cardiac events compared to peers without diabetes (3.31% versus 2.33%, P=0.198). This held up for the individual components of that composite endpoint:

Cardiac death: 0.86% versus 0.62% (P=0.579)

Target vessel MI: 0.43% versus 0.39% (P=1.000)

Target lesion revascularization: 2.01% versus 1.32% (P=0.235)

The risk of stent thrombosis was also similar between groups (0.86% versus 0.54%, P=0.379), said Luca Testa, MD, PhD, of IRCCS Policlinico San Donato in Milan, whose group gathered the records of participants in the en-ABL registry.

"These results, to the best of our knowledge, are unprecedented with other second- or third-generation drug-eluting stents," according to Testa.

Statins for Carotid Artery Stenting

Patients who took statins right before carotid artery stenting had fewer adverse events within 30 days, one meta-analysis suggested.

From 11 studies with more than 4,000 patients, Anil Jonnalagadda, MD, of MedStar Washington Hospital Center here, and colleagues determined that stenting recipients who received statins preoperatively were at lower risk of stroke (OR 0.39, 95% CI 0.27-0.57) and death (OR 0.30, 95% CI 0.09-0.95) later on.

However, they did not observe fewer reduced transient ischemic attacks or MIs, and suggested randomized trials to test the safety of this approach.

Ultrasound Renal Denervation

Blood pressure reductions held up 1 year after use of the Paradise system that delivers circumferential ultrasound energy to maximize nerve coverage during sympathetic denervation, a single-arm post-marketing study found.

A group of 96 adults who had resistant hypertension without moderate or severe renal insufficiency were enrolled with baseline office systolic blood pressure averaging 176 mm Hg and 24-hour ambulatory pressure of 156 mm Hg.

"This single-arm study represents the largest cohort of patients treated with the Paradise Renal Denervation System to date. Within the ACHIEVE trial, the therapy appeared to be safe and effective and resulted in sustained reductions in both office blood pressure and 24-hour ambulatory blood pressure measurement," the investigators concluded.

Next up will be the randomized RADIANCE-HTN trial comparing Paradise therapy to sham control in both resistant hypertension and non-resistant hypertension.

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